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Rates and Correlates of Mental Health Symptoms in Currently Competing Elite Athletes from the Australian National High-Performance Sports System



Elite athletes are at risk of mental ill-health via exposure to sports-related stressors and the overlap in competitive playing years with the peak age of onset of mental ill-health. Despite this risk, there is a paucity of robust empirical data on mental health symptoms in currently competing athletes. The purpose of this study was to assess the prevalence and correlates of mental health symptoms in a representative, national sample of elite athletes and to compare rates against published community norms.


A cross-sectional, anonymous, online survey was administered to all categorised (e.g. highest level) athletes, aged 17 years and older, registered with the Australian Institute of Sport (n = 1566). Main outcomes were self-reported scores on validated measures of psychological distress, probable ‘caseness’ (i.e. the experience of mental health symptoms that would usually warrant a need for care by a health professional), risky alcohol consumption, body weight and shape dissatisfaction, self-esteem, life satisfaction and problem gambling. Correlates of outcomes included demographic, individual vulnerability (e.g. social support, coping style) and sport-related variables.


The participation rate was 51.7% (n = 810), of whom 749 athletes completed most or all outcomes measures. Compared to published community norms, athletes were significantly more likely to report ‘high to very high’ psychological distress (9.5% vs 17.7%, respectively) and to meet the threshold for ‘probable caseness’ (19% vs 35%). In contrast, athletes reported significantly lower rates of risky alcohol consumption, problem gambling and body dissatisfaction compared to community norms, and conversely higher self-esteem and life satisfaction. The adjusted odds of psychological distress and caseness were increased in athletes who reported prior treatment for a mental health problem (OR = 1.28–2.84), inadequate social support (OR = − 2.59 to 0.37) and more recent adverse life events (OR = 0.61–1.32); while, the odds of risky alcohol consumption were lower in female athletes (OR = − 1.36) and para-athletes (OR = − 1.20).


In a representative and national sample of currently competing elite athletes, inclusive of gender and para-status, psychological distress and probable caseness were elevated relative to community norms, although other aspects of functioning were as good as, if not better than, community peers. Sports medicine and mental health professionals working with elite athletes should screen for psychological distress in athletes who may otherwise appear to be well-functioning, to provide timely, optimal treatment.

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We thank Mr Daniel Josifovski for his assistance with the survey logistics, Dr Tim Spelman and Ms Emily Mawson for assistance with data analysis and Ms Kate Gwyther for assistance with the manuscript preparation.

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Correspondence to Rosemary Purcell.

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This study was funded by the Australian Sports Commission.

Conflict of Interest

Authors Butterworth and Clements are employed by the Australian Institute of Sport, which is funded by the Australian Sports Commission. Their involvement in the study included the survey design, data interpretation and contributions to the final draft manuscript, but not to the survey implementation or data analysis. The remaining authors have no conflicts of interest to declare.


The study was approved by the University of Melbourne Human Ethics Research Committee (#1442705). All participants were provided with information about the purpose and nature of the survey prior to commencing and informed consent was implied by athletes choosing to click to ‘enter’ the survey.

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Purcell, R., Rice, S., Butterworth, M. et al. Rates and Correlates of Mental Health Symptoms in Currently Competing Elite Athletes from the Australian National High-Performance Sports System. Sports Med (2020).

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